AUGUSTA — Like the audience waiting for the next episode of a popular TV drama, news outlets, pundits, bloggers and people scanning the news over their morning cup of joe await word about the Supreme Court’s ruling on the federal Affordable Care Act as if anticipating the dramatic season finale.

Over the last month, speculation about how the court will rule and what it might mean has been rampant — and rightfully so. Whatever the court decides, the ruling will affect the health care of every man, woman and child in our nation.

If you talk to people in your community about the ACA (also known as “Obamacare”), you’re likely to hear a wide range of opinions. Repeat polling has shown the public remains largely split over the law, with a majority of Democrats supporting it, and a somewhat larger majority of Republicans opposing it.

For the most part, people find the law very confusing, making it more likely that sound bites rather than in-depth understanding are shaping people’s perceptions.

The legal fervor and public attention has largely focused on the law’s requirement that everyone must have health insurance coverage or face a financial penalty (the “individual mandate”). Public opinion polls consistently show this is the most unpopular provision in the law.

Yet, those of us who drive are familiar with this type of insurance mandate. In Maine and many other states, drivers must have auto insurance to register their cars. It’s a basic principle, so you and the other guy have protection and shared risk if — or when — an accident occurs.

From an insurer’s perspective, the individual mandate is the best way to ensure that everyone contributes to and shares the benefits of being in the insurance market, and likewise, that everyone shares the risk. The ACA’s goal is for everyone to be in the market whether they enjoy good health or have a significant illness. We all pay in because at some point in our lives illness will strike, and we’ll all need health care.

Other parts of the law have been largely embraced by the public, particularly with regard to other insurance policy reforms. For example, young adults and their parents have enthusiastically welcomed the ability to keep adult children on their plans until age 26.

A recent Commonwealth Fund study found that 6.6 million young people signed onto their parents’ private insurance plans since that provision of the ACA took effect over the last two years.

Preserving some of these more welcome reforms may be challenging in the wake of the court’s decision. Many have argued that the whole structure of the ACA insurance reforms unravels if the requirement for everyone to purchase insurance is struck down. The court will weigh in on this issue called “severability.”

If its ruling supports the concept of an inseverable link between the individual mandate and other parts of the law, then the path forward for the ACA and preservation of many of its insurance reforms will be thrown into turmoil.

If the individual mandate is overturned, some important elements of the law can endure. There are many provisions and concepts that can be implemented by insurance companies, federal agencies, employers and health care providers without the mandate.

The federal health reform law provides a more uniform structure for all of these policy changes, so they complement each other, rather than being implemented piecemeal, one population or program at a time.

Perhaps the most discouraging outcome of a court ruling that would strike down the ACA is the prospect that our country, once again, would be cast adrift without a unifying national framework that can focus and converge our local efforts to transform America’s health care system so it works better, at less cost, for everyone in every state.

The prospect of returning to pre-ACA business as usual — where health care costs continue to rise unabated, leaving more and more people uninsured and unable to access care — is distressing at best.

But we must also remember that the court drama is just one part of the health reform story.

Many of Maine’s hospitals and health care providers, business leaders, insurers and advocates know that whatever the Supreme Court decides, they won’t curtail their collaborative work to push forward key elements of reforming the health care system.

When the court finally speaks, this episode of the continued drama around the ACA will conclude. But in real life, health care leaders in Maine will keep moving ahead with new ideas about tools and resources that the ACA brought to the table that we can use to keep Maine’s progress in pushing reform forward — with or without the ACA.

Wendy J. Wolf, M.D., MPH is president and CEO of the Maine Health Access Foundation in Augusta.

– Special to The Press Herald